MEMBERSHIP FORM
Canada Japan Society of Ottawa
Name: _____________________________________
Street Address: ______________________________
__________________________________________
Telephone:
Home: __________________
Office: __________________
E–mail address: ______________________________
Please check type of membership desired:
New_______
Renewal ____
_____ Individual, $10
_____ Family, $25
_____ Student or Work/ Holiday Visa, No Charge
Re: family membership, please list family members and indicate ages of children under 16:
_______________________________________________________________________________________________________________________________________________________________
For a CJSO Reminder/ Confirmation of Attendance at Monthly Events (Please check one only):
Contact me by e-mail: _____
Contact me by phone: _____
Pleas make your cheque or money order payable to:
Canada Japan Society of Ottawa
2823 Mozart Court
Ottawa, ON K1T 2P6
